Simultaneous Kissing Stenting for the LM Bifurcation Lesion

- Operator : Seung-Jung Park

Simultaneous Kissing Stenting for the LM Bifurcation Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 79-year-old male was admitted for effort chest pain. The recent coronary angiography from other hospital showed severe stenosis at the proximal left anterior descending artery (LAD) and proximal left circumflex (LCX). His coronary risk factor was hypertension and ex-smoking. The physical exam was unremarkable, electrocardiogram showed sinus bradycardia. The echocardiography showed normal findings with the ejection fraction of 58%.
Baseline Coronary Angiogram
  1. The left coronary angiogram & IVUS showed significant stenosis with diffuse calcification from proximal to middle LAD and LCX ( Movie 1). Severe eccentric stenosis at the LAD ostium was remarkably identified.
  2. The right coronary angiogram showed significant stenosis at the mid-RCA.
Procedure
A 8Fr sheath was inserted through the right femoral artery and, left coronary artery was engaged with a 8 Fr JL 4 guiding catheter. 0.014-inch Sion 180 cm wire was inserted into the LAD. Pre-dilation performed with a SAPPHIRE NC 2.5 x 18 mm balloon and Angiosculpt 3.0 x 15mm balloon ( Movie 2, Movie 3). Two Xience stent 3.5 x 23 mm and 3.5 x 15 mm were deployed at LAD and LCX ( Movie 4) at the same time. Simultaneous kissing ballooning was performed by using SAPPHIRE NC 3.5 x 18 mm and Raiden3 3.5 x 20 mm balloon at pLAD and pLCX ( Movie 5). The final angiogram and IVUS showed successfully implanted stents ( Movie 6). The right coronary lesion was treated with a Xience 3.25 x 15 mm as well.

Appendix
IVUS image of pre-procedure ( Movie 7) and final image ( Movie 8)

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